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Sunday, September 16, 2012

Writing Behavior Plans

Disclaimer:The information in this post is intended to be a general
guide to writing a behavior plan. Behavior plans, like FBA’s, must be
an individualized, needs-specific process. As a parent or professional, please
avoid “paint -by -number” guides to writing behavior plans. Like most
professionals, I do follow somewhat of a template when I create behavior plans.
However, it’s just a basic shell for me to individualize depending on the client. Various funding sources
(such as different insurance companies) will have different requirements of how
they want the behavior plan to look, so again, trying to stick too closely to a
formula definitely wont help you. Besides, the creating is the best part!

End of disclaimer.

What is a behavior plan?

A behavior plan is
the last step in the FBA process. When dealing with any behavior you want to
reduce, a FBA is completed to determine the function of the behavior. Once a
function is determined, then a behavior plan is created. ABA professionals also
use the terms Intervention, Behavior Reduction Strategies, or Plan of Action.
Teachers may use the terms Behavior Intervention Plan, or Positive Behavior
Support Plan. We are both describing the same thing: a behavior plan.

* Some agencies or school systems will write behavior plans for
appropriate behaviors that need to be increased, such as manding or greeting
peers. In my experience, skill acquisition goals, or programs, are used for
appropriate behaviors, and behavior plans are used for inappropriate behaviors.

Why do I need one?

The FBA describes
why the behavior is happening, and the behavior plan is the strategy for what
to do about the behavior. Neither is complete without the other: skipping
straight to behavior plan writing is essentially making a guess about what
might work. Completing a FBA and then failing to write a behavior plan is a
waste of time, resources, and (possibly) money, because you have a function for
the problem behavior but no plan of how to reduce it. The FBA and the behavior
plan are meant to go together…think of them as peanut butter and jelly.

Who can write one?

That depends on the
setting. A parent can create a behavior plan for their child, to implement in
the home. A teacher can usually create a behavior plan to use with a student;
although various schools have policies on how/when a behavior plan can be
written. In some schools, only Behavior Analysts or the School Psychologists
can write a behavior plan. At other schools, teachers can complete the entire process. An ABA professional, usually at the BCBA or BCaBA
level, can write a behavior plan if there is a demonstrated need for one. The
setting and the severity of the problem behavior will determine who can write
the behavior plan.

How do I write a behavior plan?

The good news: It’s
not as hard as it sounds. The bad news: It can be an intricate and lengthy
process, and may take some time to get the hang of it. Experience is the best
teacher, and the more behavior plans you write the easier the process becomes.

The standard
components of a behavior plan include: demographic/identifying information,
client history/background, problem/target behaviors including an operational
definition, function of the behavior (this comes from the FBA) including actual
data, strategies to decrease the problem behaviors based on the function including
replacement or incompatible behaviors, data collection sheets/graphs to monitor the
success of the behavior plan.

Can I see a sample?

Sure! Below is a
sample behavior plan for “John Doe”, with an explanation of each component. Use
this as a basic guide or learning tool. The school or company you work for may
have behavior plans that look very different from this sample…that’s normal.
Even in the same company, behavior plans can vary depending on the funding source.

History: John is a 31 year old Cuban-American male who resides in a
state licensed community residence in Norcross, GA. He resides in the home with
two other male residents, one of whom is a recent addition. John is a friendly
and sociable person, who enjoys watching TV and visiting the community pool.
John has a history of elopement, emotional outbursts, and anxiety. John sees
his psychiatrist every 3 months, and is on a limited sodium diet. John’s
challenging behaviors had been latent since March of 2012, and have recently
increased in frequency. The most recent behavioral event occurred in August of 2012
when John attacked a staff member during lunch time. Staff members at the residence
report that John’s challenging behaviors often occur randomly, and for no
apparent reason. Staff states that John will be calm and quiet, and then will
suddenly lash out.

This behavior plan
was created based on John’s history and current behavioral problems, and to
ensure that staff members are aware of the protocols that must be kept in place
to support John.

(The
history, or background, is usually obtained from record review or parent/staff
interview. Include a variety of information to give a snapshot of the
individual, what they like, what behaviors are occurring, frequency of
behaviors, staff/parent reaction to behaviors, and remember to include any
suggested functions of the behavior that the parents or staff mention. In this
example, the staff gave the function of “no reason”. As non-helpful as this
response is, it’s very common that during the interview the parent or staff
will tell you the behavior has no function and “just happens”.)

Problem Behaviors:

1. Physical
Aggression- Defined as John attempting to or successfully punching another
person with a closed fist, or slapping with an open palm against the body of
another person. This behavior typically occurs when John is given a demand.

2. Vocal Threats-
Defined as John making inappropriate expressive statements directed towards others,
pertaining to causing physical harm. This behavior does not include when John is "scripting" dialogue from a TV show or movie.

(An
operational definition is a way of defining a behavior in simple, observable
terms. Avoid using definitions that are vague, overly technical, or can’t be
observed—like thinking. The reason it’s important to define the problem
behavior is so that everyone is intervening on the right behavior. If one
person describes a hit as a “punch” and another person thinks a hit is a
“slap”, then those two people will be intervening differently, which will cause
the behavior plan to be ineffective. Its a good idea to include exclusions of the problem behavior: what the behavior is not)

Function of Behaviors: Based on the results of the FBA (see
attached), John is most likely to engage in physical aggression or verbal
threats when staff member Kevin is on duty. Frequency of physical aggression or
verbal threats increased by 75% when Kevin was present. John is least likely to
engage in physical aggression or verbal threats when he is engaged in a
preferred activity, or interacting with staff member David, or staff member
Bobby. The hypothesized function of both the physical aggression and the verbal
threats is attention. Currently, the staff only give direct statements or
conversation to John during daily routines, such as telling him to make his bed
or turn off the TV. It was observed that in a 5 hour period, no reinforcement
or praise was given to John. When John exhibits problem behaviors, staff will
speak in a loud tone of voice, sit near John, or talk to John to calm him down.
It was also observed during the FBA that the non-targeted staff members will
often run into the room when John begins exhibiting problem behaviors, and 2-3
staff members will simultaneously attempt to calm John down.

(The
FBA and accompanying data would be attached to this behavior plan. It’s typical
to use a color coded line graph. Make data based decisions by using the data to
confirm or deny your hypothesized function. Along with the results of the FBA,
refer to information obtained during interview or observation to bolster your
findings.)

Behavioral Strategies/Intervention: Staff member Kevin will switch shifts with
staff member Lonnie, so that Kevin is working at night when John is asleep. Staff
member David had the least amount of aggression directed towards him (3%), and
he appears to be very reinforcing to John. Staff member David will be the main
staff assisting John throughout the day, and will watch a 30 minute TV show
with John 3 times per day. For every 10 minutes that John is calm and quiet, he
will earn one token. At the end of 30 minutes if John has at least 2 tokens
then he can earn extra TV time, or select a staff member to take him to the
community pool. When delivering a token provide behavior-specific praise with
eye contact, such as “Great job reading quietly, John”. If John exhibits
problem behavior, use blocking and a 2 person restraint hold to maintain
safety. Avoid direct eye contact with John, and use minimal language with a
calm tone of voice. No other staff member should be present except the 2 staff
members performing the restraint hold. If John begins making verbal threats, do
not respond. Do not engage John in conversation or argue with John. Once John
is calm and has stopped making threats, provide eye contact and redirect John
to an appropriate activity.

(A
good number of recommended strategies is 2-4. Avoid giving just 1 suggestion, because
the staff/parents may dislike that option and refuse to carry it out. If the parents or staff do not agree with your behavior plan then you must revise it--you must get the people who will implement the behavior plan on board with following it. Include
simple strategies as well as more complex strategies. Since the behavior happened the most
with Kevin, the simplest option is to remove Kevin from the environment. The
more complex option would be to implement a system of reinforcement, and to
give John an appropriate way to gain staff attention. A replacement behavior
is what you want the person to do instead of the problem behavior. An incompatible
behavior is something that the person cannot do at the same time as the
problem behavior. You will not be able to come up with a replacement behavior
for every problem behavior, and sometimes you have to settle for an
incompatible behavior, or shaping the problem behavior into something more
appropriate.)

Data Collection: See attached ABC data collection sheet, in
order to monitor the success of the behavior plan. Data should be collected
daily for at least 45 minutes, across staff members.

(Continued data collection is critical after creating and
implementing a behavior plan. A behavior plan is considered successful only
after the data has shown a reduction, or elimination of the problem behavior.
It isn’t unusual to go through all of these steps, implement the behavior plan,
and the data shows no change in the problem behavior. If that happens, don’t
give up-- just roll up your sleeves and review your data to see where the
problem lies.)

10
comments:

I love your blog it's amazing! So much time and effort has clearly gone into your posts. We have a four year old boy with Lots of attention seeking(I think from reading this post) behaviour and your suggestions will help me help him! Keep blogging please!

I do like single data collection (single occurrence per session vs recording data after each response). I have worked for enough employers to know usually single or multiple data collection is preferred, but I think both have their pros and cons. It really just depends on what you need to see from the data and if the method you are using gives you enough information to make teaching decisions. What I like about taking cold probe data is definitely how it frees up the staff to be more connected with the client. With trial by trial data often you will see staff teach/interact with the client, and then they are bent over a a clipboard furiously recording data. In a cold probe scenario, once you have recorded your responses at the start of the session you are then free to just teach. As a supervisor, I think a con of cold probe data collection is the Y/N recording doesn't clearly give me information about progress (has the client moved from needing a full physical prompt, to only a gestural prompt).